Everything You Thought You Knew About the Physician Shortage: The Specialty (Neurosurgical) Perspective

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1 Everything You Thought You Knew About the Physician Shortage: The Specialty (Neurosurgical) Perspective Presented by: H. Hunt Batjer, MD Darwin E. Smith Distinguished Chair in Neurological Surgery, The University of Texas Southwestern Medical Center President Elect, American Association of Neurological Surgeons President Elect, Society of Neurological Surgeons

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3 Key Points Increasing Demand for Surgical care Distribution/ Maldistribution of Surgeons Poor availability of Trauma and Pediatric specialty services in many areas The Aging Surgeon Problem The Neurosurgical Pipeline Problem Implications of GME Funding Decisions

4 Increased Demand for Specialty Care Source: Health Affairs

5 Increased Demand for Specialty Care Source: Medicine Use and Shifting Costs of Healthcare. Report by the IMS Institute for Healthcare Informatics.

6 Significant Appointment Wait Times Specialty (Adults) Wait Time (Days) Neurology 34.8 OB GYN 27.5 Neurosurgery 24.1 Dermatology 22.1 Family Medicine 20.3 Orthopaedic Surgery 16.8 Cardiology 15.5 Source: Health Affairs Specialty (Pediatrics) Wait Time (Days) Developmental Pediatrics 101 Genetics 76 Neurology 62 Rheumatology 55 Dermatology 54 Child Psychology 52 Endocrinology 51

7 Number of People per Active Physician Neurosurgery: 1/61,235

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9 Maldistribution of Surgeons 25% of the U.S. population lives in county w/out a neurosurgeon 50% percent of the U.S. population lives in counties w/ 15.5% of neurosurgeons Source: American College of Surgeons Health Policy Research Institute

10 Higher Maldistribution Rate Among Specialists More even distribution of primary care Neurosurgery and ophthalmology highest maldistribution Reason: Need high population areas to sustain quality practice Source: American College of Surgeons Health Policy Research Institute

11 Neurosurgeons Per 100,000 Population, 2011 Most counties have NONE Source: American College of Surgeons Health Policy Research Institute

12 Level I Trauma Centers, 2010 Nearly 25% of population is not w/in 60 minutes of a Level I trauma center Neither Alaska or Hawaii have Level I trauma centers Source:

13 Surgeons are Getting Older Source: American College of Surgeons Health Policy Research Institute

14 Aging Workforce = National Problem Source: American College of Surgeons Health Policy Research Institute

15 Even a Bigger Problem in Rural Areas Source: American College of Surgeons Health Policy Research Institute

16 Number of Neurosurgeons by Age Age Range 44% of practicing neurosurgeons over the age of 55 Source: American Board of Neurological Surgery

17 Neurosurgery Workforce: Basics In 2013, 3,771 practicing board certified neurosurgeons Over 5,700 hospitals 1,600 provide some trauma care 1,000 are certified primary stroke centers 200 are children s hospitals More than 317 million people Aging population in need of care for neurologic problems such as stroke, degenerative spine disease, Parkinson s Sources: Neurosurgery Statement to IOM Ensuring an Adequate Neurosurgical Workforce American Board of Neurological Surgery

18 Neurosurgical Training: Basics Neurosurgical training is unique 105 accredited residency programs in the U.S. 1,200 total residents 160 graduates complete residency per/year Length of post graduate residency training for neurosurgeons is among the longest = 7 years Subspecialty fellowship adds additional 1 2 years TOTAL from medical school thru board certification = 18 yrs. Policy/ Funding Changes take YEARS to have an impact The Pipeline Problem Source: Neurosurgery Statement to IOM Ensuring an Adequate Neurosurgical Workforce

19 Cost to Train a Neurosurgery Resident Institutional Costs Total Institutional Costs $65,621,392 Divided by 442 residents Departmental Costs: $148,465 (per res/per year) 20% Salary & Benefits for Program Director $260,396 Salary & Benefits for Program Coordinator $39,741 Travel and Conferences $14,039 Food $7,998 Books and Equipment $5,366 Licensing $4,761 Interview Costs $3,641 Miscellaneous $1,431 Total Department Costs $337,373 Divided by 14 residents Total Costs: $172,563 per resident/per year x 7 years Source: Neurosurgery Statement to IOM Ensuring an Adequate Neurosurgical Workforce $24,098 (per resident/per year) $1,207,941 (per resident)

20 Neurosurgery Residency Match Data Year PGY 1 Applicants Positions Offered Positions Filled Percent Filled Source: National Residency Matching Program

21 Neurosurgery Residency Match Data Applicants Offered Filled Applicants Offered Filled Applicants Offered Filled Applicants Offered Filled Applicants Offered Filled Applicants Offered Filled Source: National Residency Matching Program

22 Residency Growth by Specialty, ,500 3,000 2,500 2,000 1,500 1,000 Specialty 5 Year Change % 5 Year Change Family Medicine % Neurology % Neurosurgery % Orthopaedic Surgery % Otolaryngology % Physical Med & Rehab % Primary Medicine % Surgery % TOTAL 4, % Neurosurgery is Falling Behind! Source: National Residency Matching Program

23 Primary Care Number of First Year Residents by Specialty Neurosurgery: 195

24 Neurosurgical Workforce Shortages Only 83% of neurosurgeons take emergency call 24/7/ board certified pediatric neurosurgeons w/in next decade, 42% will retire Only 6 enter workforce each year, falling short of demand Job data demonstrate shortages: in 2011, 305 vacant neurosurgery positions in the U.S. 192 generalists, spine focused neurosurgeons, or unidentified 113 subspecialists, including neurovascular, endovascular, pediatric Sources: Neurosurgery Statement to IOM Ensuring an Adequate Neurosurgical Workforce American Board of Neurological Surgery

25 Medical School Grads Entering Residencies vs. Available Positions 24.5% Reduction in Positions Estimated w/cuts in GME funding

26 Implications of GME Cuts Source: Journal of Graduate Medical Education Positions Lost = 33,000

27 Snapshot of Texas Texas population growing faster than most other parts of the country: 500,000 per year Overall, and in virtually every medical specialty, Texas has fewer physicians per person than the rest of the U.S. Ratio of Physicians per 100,000 Tex. Ratio as % of U.S. Ratio Specialty Texas U.S. All Physicians % Emergency Medicine % Family Medicine % Neurology % Neurosurgery % Orthopaedic Surgery % Otolaryngology % Pediatrics % Physical Med & Rehab % Surgery % Source: Texas Medical Association, Medical Education Department

28 Concluding Thoughts In Texas alone, to keep up with our population growth we need to produce 2 ½ to 3 ½ doctors PER DAY! Cuts to GME funding will exacerbate current physician shortage. To alleviate current and future physician shortage, Congress should pass legislation increasing Medicare support for GME. We will be short 65K Specialists as well as 65K PCPs in the US by 2025!

29 For More Information Katie O. Orrico, Director Washington Office American Association of Neurological Surgeons

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